Specifically, preoperative cognitive impairment moderated the association between the intervention and burst suppression. Our results suggested a potential mechanistic insight into the relationship between EEG suppression and postoperative delirium. However, we did not find that the anesthetic doses differed between study group. What we found was that targeting a dimensionless processed EEG value reduced the percent of surgical time spent in burst suppression, particularly in those with preoperative cognitive impairment.
#BURST SUPPRESSION EEG TRIAL#
Accordingly, we conducted an exploratory randomized controlled trial to determine whether the use of a processed EEG monitor to guide anesthesiologists to keep a dimensionless processed EEG value above a specified value reduced intraoperative burst suppression when compared to standard anesthetic care ( Anesth Analg 2020 131:1228-36). Prior studies also did not consider whether preoperative cognitive status influences the effects of anesthetic on the brain. Provoking a postoperative state of delirium is a complex, multifactorial process that is unlikely to be dependent on a linear relationship to a single variable. Further, it is unclear to what extent the clinician can simply modulate the anesthetic dose to minimize time spent in burst suppression, thereby reducing postoperative delirium. that had a slightly different study goal in which patients undergoing hip fracture surgery and spinal anesthesia were monitored with processed EEG with the bispectral index (BIS) and randomized to receive either deep (BIS, approximately 50) or light (BIS, ≥80) sedation, the relationship between the use of processed EEG and reduced incidence of postoperative delirium was no longer significant ( Anesth Analg 2020 131:712-9).Īssuming that the use of a processed EEG does result in a reduction of postoperative delirium, a major unanswered question is whether the effect is directly via a reduction in EEG activity or some other associated mechanism linked to a reduction in anesthetic dose. However, if excluding the one study by Sieber et al.
![burst suppression eeg burst suppression eeg](http://eegatlas-online.com/myapplications/images/eeg0082/eeg0082.png)
The aggregated OR computed between processed EEG monitoring and postoperative delirium for all six studies using the fixed-effects model was 0.66 (p<0.001 95% CI, 0.55 to 0.77 I 2=40%) (Figure).
![burst suppression eeg burst suppression eeg](http://eegatlas-online.com/myapplications/images/eeg0090/eeg0090_ipsiEaron.png)
Including the data published more recently by the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes trial ( JAMA 2019 321:473-83) resulted in the accompanying forest plot. The use of processed EEG-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium. ( Anesthesiology 2018 129:417-27) conducted a meta-analysis that included five studies in a quantitative postoperative delirium analysis, with data pooled from 2,654 patients ( Mayo Clin Proc 2010 85:18-26 J Neurosurg Anesthesiol 2013 25:33-42 J Anesth Clin Res 2012 3:6 Br J Anaesth 2013 110 Suppl 1:i98-105 Anesth Analg 2014 118:809-17). On the level of brain inactivation during anesthesia.Leung et al. Multi-channel burst-suppression EEG but can also generate additional insights Neurophysiology-informed model not only provides unsupervised segmentation of Our latent state estimates are determinedįrom data using a sequential Monte Carlo algorithm. The rate constants governing the ATP kinetics are allowed to vary asįirst-order autoregressive processes. The two brain statesĪre allowed to stochastically alternate with transition probabilities thatĭepend on the instantaneous ATP level, which evolves according to first-order Network manifestation of one of two global brain states. Our model assumes Gaussian distributed data as a broadcast Kinetics from instantaneous power of multichannel EEG using a switching Infer latent states characterizing alternating brain states and underlying ATP Suppression) of adenosine triphosphate (ATP). Prior modeling studies suggest thatīurst-suppression EEG is a manifestation of two alternating brain statesĪssociated with consumption (during a burst) and production (during a
![burst suppression eeg burst suppression eeg](https://media.springernature.com/full/springer-static/image/art%3A10.1186%2F1471-2377-5-14/MediaObjects/12883_2005_Article_63_Fig7_HTML.jpg)
Segments of near-isoelectric inactivity (suppressions) and relatively Its distinctive feature is alternation between short temporal Profoundly inactivated brain states characterized by cerebral metabolicĭepression.
#BURST SUPPRESSION EEG PDF#
Brown Download PDF Abstract: Burst suppression is an electroencephalography (EEG) pattern associated with Authors: Gabriel Schamberg, Sourish Chakravarty, Taylor E.